See Figs. 1 and 2.

The treatment strategy began with an aggressive debridement to minimize infection risk. Once the soft tissues had stabilized, the surgical options to treat the femoral defect were considered. A significant segment of femur was missing distally, so a transverse subtrochanteric osteotomy was planned (Fig. 3a). The proximal femoral segment would then be transported by external fixation over a femoral nail. On hospital day number 6, an osteotomy was performed, and a monotube external fixator and a retrograde femoral nail were placed (Fig. 3a–c). The surgical plan was to transport the proximal femur into the distal defect (Fig. 4a, b). After 2 months of transport, the distal defect spontaneously healed, and no further transport was required (Fig. 5a–c). The femoral cortices were reconstituted, continuous and tolerant of full weight-bearing. The patient noticed several months later that her leg was short 3 cm. She requested a lengthening procedure, which required 4 months to complete.